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Partial splenectomy in children: An alternative for splenectomy in the pathological staging of Hodgkin's disease

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Abstract

Background: The more accurate staging of Hodgkin's disease in children is achieved with a staging laparotomy and splenectomy. A disadvantage of the splenectomy is the high risk for an overwhelming postsplenectomy sepsis (OPSI). Therefore, the partial splenectomy was introduced as an alternative to splenectomy in the staging of Hodgkin's diseases in children.

Methods: During the period 1982–1988, 12 children with Hodgkin's disease underwent a staging laparotomy with partial splenectomy. All patients were preoperatively vaccinated withPneumococcus vaccine. The first three patients received 44 Gy locoregional radiotherapy, whereas nine patients received 25 Gy locoregional radiotherapy and two courses of MOPP/ABVD (mitoxin, oncovin [vincristine], procarbazine, prednisone/adriamycin, bleomycin, vinblastine, decarbazine).

Results: The morbidity was negligible. The pathological stage changed in three patients (25%). During a median follow-up of 6 years (range 4–10), no OPSI was diagnosed. One patient developed a secondary leukaemia.

Conclusions: Staging laparotomy for Hodgkin's disease is being performed with less frequency because the majority of patients are treated with chemotherapy and low-dose radiation therapy. After splenectomy and chemotherapy regimens with alkylating agents, there is an increased risk for secondary acute leukemia. With partial splenectomy an adequate staging of the disease can be achieved, allowing a more tailored therapy so that systemic chemotherapy will not be used as frequently, resulting in a lower treatment morbidity without decreasing survival.

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Authors and Affiliations

  1. Department of Paediatric Oncology, University Hospital Groningen, Groningen, The Netherlands

    Rienk Y. J. Tamminga MD, PhD

  2. Department of Pathology, University Hospital Groningen, Groningen, The Netherlands

    Wim Timens MD, PhD

  3. Department of Surgical Oncology, University Hospital Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands

    Harald J. Hoekstra MD, PhD

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  1. Harald J. Hoekstra MD, PhD
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  2. Rienk Y. J. Tamminga MD, PhD
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  3. Wim Timens MD, PhD
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Hoekstra, H.J., Tamminga, R.Y.J. & Timens, W. Partial splenectomy in children: An alternative for splenectomy in the pathological staging of Hodgkin's disease. Annals of Surgical Oncology 1, 480–486 (1994). https://doi.org/10.1007/BF02303613

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  • DOI: https://doi.org/10.1007/BF02303613

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